MICHAEL E TABERNACKI OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****71

License Status

NOT RENEWED

Business

First Name

MICHAEL E

Last Name

TABERNACKI

Suffix

Business Name

MICHAEL E TABERNACKI OD

Original Issue Date

09/16/1999

Effective Date

03/13/2022

Expiration Date

03/31/2024

City

WESTERN SPRINGS

State

Zip

60558

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

02/05/2025